Brittney Butler, MPH
Statute of J. Marion Sims in New York City’s Central Park was removed in 2018.
Photo by Thomas Urbain/Getty Images
Too often when addressing health equity, we focus on developing individual based interventions aimed at reducing the overall disparity, despite a great deal of research showing how institutionalized policies and structural racism impact health outcomes for Black families. The concept of equity pushes us to move beyond the concept of equality, everyone having the same thing, to understand that in order to truly address and close the health disparities gap we must provide resources commensurate with need. The health effects of slavery and racism in the U.S has transcended generations and laid the foundation of poor health for Black families in the U.S. [1]. A comprehensive plan for reparations offers an opportunity to provide Black families, who have been minoritized and marginalized since the first enslaved African reached the shores of this nation 400 years ago, with the ability to live healthy lives.
The connection between health disparities and racism dates back to slavery [2, 3]. The Slave trade introduced European diseases to African and Indigenous populations [4], and prior to arriving to these shores, the long journey to North America and the horrible ship conditions increased risk for disease and mortality with the leading cause of death being dysentery. If they survived the treacherous journey, they were forced to live and work under inhumane conditions that further exacerbated their risk for chronic and respiratory diseases [1, 5].
During slavery, white physicians experimented on, exploited and discarded Black bodies under the auspice of advancing medicine [5]. One example is Dr. Sims, the “father” of Gynecology, carrying out risky procedures on enslaved women, without consent and anesthesia, in order to further his research on surgical treatment for various gynecological diseases—stating in an 1857 lecture to the New York Medical Association that he did not use any anesthesia because he believed the operations weren’t “painful enough to justify the trouble”, despite offering white women anesthetics for the pain. Additionally, he was known to openly embrace the theory that Blacks felt less pain than whites [5] — conceivably laying the foundation for underestimating and underdiagnosing pain management for Black patients today.
The 1619 Project’s most recent podcast outlines how once the enslaved people were free, they had minimal access to health care and other basic necessities, like housing, leading to worsening conditions and higher mortality rates. Even when services were available, through the Freedmen’s Bureau, the quality of these services and facilities were diminished. Theories that newly freed Black persons were biologically inferior and unsuitable for freedom emerged during these times and served as the rationale to divert funding from this health program.
Legal and government sponsored medical experimentation and exploitation of Black bodies continued for centuries after slavery [5]. One of the most egregious acts of legal government sponsored medical experimentation was the U.S Public Health Service’s Study of Untreated Syphilis, in which hundreds of Black men with syphilis were purposefully not given treatment to see the effects as the disease progressed, causing life-long harm to them and their families. This blatantly racist study, which began in 1932 and only ended in 1972, solidified mistrust of medical institutions and doctors in the Black community that continues to this day. Racist medical theories developed from these government sponsored research agendas continue to be taught in medical schools today, increasing bias in medical settings that results in poorer care and increased mortality for Black families.
While current conversations about reparations vary on whether to endorse them or how they should be administered, one common thread binds them together: they all focus on how legal and systemic forms of racism have created vast wealth disparities — especially between white families, the beneficiaries of slavery, and Black families — at whose expense these gains have been made. Unfortunately, an important connection has been neglected: systemic racism in the United States created the health gap we see today.
The solutions we propose to address a public health problem are directly informed by our understanding of the problem.
A growing body of research documents the current impact of structural racism on health outcomes and behaviors for Black families in the U.S. Policy has been a key way to maintain racism in the U.S. ranging from redlining, to disparities in educational funding and spending, to vast incarceration disparities, just to name a few, structural racism has disproportionately affected health outcomes for generations of Black families. The solutions we propose to address a public health problem are directly informed by our understanding of the problem. I believe we must stand collectively to address how structural racism impacted health and look for solutions that will work and last.
I believe that reparations should include a direct financial payment to descendants of enslaved Africans in the U.S, to begin to address the wealth gap. But as a Black PhD student who studies racism and pregnancy, I know all too well my own increased risk for pregnancy complications, maternal death, and my baby’s chances of dying before their first birthday. I also know that my future doctoral degree and income doesn’t protect me from this reality because despite wealth and health being deeply intertwined, changes in the wealth gap alone will not eliminate health disparities. The persistent effects of structural racism will always be at the root of these health disparities.
That’s why any conversation around reparations must also include a comprehensive plan for ongoing anti-racist policies and restitution for Black families in order to also address health equity.
One example of an anti-racist and restorative policy would be federally decriminalizing formerly incarcerated drug offenders, who are disproportionately Black. Having a “record” creates barriers to the social determinants of health such as accessing social services [6], obtaining housing [7] and employment [8], and furthering education [9], all of which contribute to health inequities. President Obama introduced six executive orders in an effort to reduce these barriers for formerly incarcerated persons including a pilot program offering Pell grants to further education after release and updating HUD’s guidelines addressing discrimination based on felony status. These programs and revisions were quickly rolled back by the Trump administration. If we provide formerly incarcerated persons a true chance to thrive, we will start to see an improvement in overall health outcomes for all Black families, including Black maternal and infant mortality.
Health inequities have been woefully neglected in the conversations about reparations.
Policy makers may deny the existence and legacy of racism, while simultaneously benefitting from it and fighting to keep its very structure intact. For example, Mitch McConnell avidly opposes reparations saying “I don’t think reparations for something that happened 150 years ago, when none of us currently living are responsible, is a good idea.”, despite being the great-great-grandson of slaves owners and directly benefitting from the wealth built on these plantations. The reality is we can no longer afford to live in an inequitable society. Health care costs due to disparities caused by racism and its downstream effects cost this country billions of dollars annually. In fact, eliminating racial disparities would be very good for our economy, research shows that the GDP in our country could be 2.1 trillion dollars higher without them. A comprehensive plan for reparations could actually be a healthcare cost savings plan.
Regrettably, health inequities have been woefully neglected in the conversations about reparations. Now more than ever, health in all policies should serve a lens through which we examine the critical need and plan for reparations. Experiences of racism over generations impact our health and we must address the role and responsibility of the United States to address health inequities. Reparations could be a key tool to achieve health equity for Black families. As reparations is being discussed on a national scale, it’s time public health professionals learn more about efforts such as House Resolution (HR) 40 and add their expertise so that any plan for reparations that moves forward strives to address all of the consequences of slavery and racism in the United States--including health inequities.
Brittney Butler is a doctoral student in the Division of Epidemiology at The Ohio State University College of Public Health studying structural racism and pregnancy complications. She is a Robert Wood Johnson Foundation Health Policy Research Scholar. Follow her on Twitter @BrittneyButler_
References
1. Hood RG. The" slave health deficit:" the case for reparations to bring health parity to African Americans. Journal of the National Medical Association. 2001; 93:1.
2. Gaskin DJ, Headen Jr AE, White-Means SI. Racial disparities in health and wealth: The effects of slavery and past discrimination. The Review of Black Political Economy. 2004; 32:95-110.
3. Byrd WM, Clayton LA. Race, medicine, and health care in the United States: a historical survey. Journal of the National Medical Association. 2001; 93:11S.
4. Curtin PD. Epidemiology and the slave trade. Political Science Quarterly. 1968; 83:190-216.
5. Washington HA. Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present: Doubleday Books; 2006.
6. Mallik-Kane K, Visher CA. Health and prisoner reentry: How physical, mental, and substance abuse conditions shape the process of reintegration: Urban Institute Justice Policy Center Washington, DC; 2008.
7. Evans DN, Blount-Hill K-L, Cubellis MA. Examining housing discrimination across race, gender and felony history. Housing Studies. 2019; 34:761-78.
8. Agan A, Starr S. The effect of criminal records on access to employment. American Economic Review. 2017; 107:560-64.
9. Mallory J. Denying Pell grants to prisoners: Race, class, and the philosophy of mass incarceration. International Social Science Review. 2015; 90.
